Healthcare Provider Details

I. General information

NPI: 1447586920
Provider Name (Legal Business Name): CHING G. LEE M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S. BEACH BLVD #203
ANAHEIM CA
92804-1877
US

IV. Provider business mailing address

408 S. BEACH BLVD. #203
ANAHEIM CA
92804
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-9111
  • Fax: 714-527-7426
Mailing address:
  • Phone: 714-527-9111
  • Fax: 714-527-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG61762
License Number StateCA

VIII. Authorized Official

Name: CHING G LEE
Title or Position: OWNER
Credential: M.D.
Phone: 714-527-9111